WINTER MUSIC STUDIO/BRILLIANCE MUSIC ACADEMY

Students Online Registration/Contact Form

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Email *
Student’s Full NAME *
Birth Year *
Parent’s Full NAME *

ENROLLEMENT: Piano/Violin/Drum

 *
Home Address:
What is your phone number? *
What is your email address? *
Would you like to receive lesson reminder? *
How did you hear about us?  Please select.
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If friends referral, please specify who, please write here.
If you have more questions or concerns, please write here.
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